婴儿期双眼先天性白内障术后远期疗效观察

Long-term outcome after bilateral cataract surgery in infants with congenital cataract

目的探讨婴儿期双眼先天性白内障手术治疗的安全性和远期术后效果。方法回顾性系列病例研究。2003年3月至2009年3月北京大学人民医院眼科收治的婴儿期双眼先天性白内障患儿31例（62只眼），所有患儿均接受了同期双眼白内障吸除、后囊膜切除及前段玻璃体切除手术，术后进行密切随访，对末次检查时的单眼视力、双眼视力结果进行统计，并对患儿末次随访时的双眼最佳矫正视力与随访时间进行Pearson相关分析。结果患儿手术年龄中位数是3个月（0．5～11个月），术后随访时间中位数是4．0年（3．0～8．5年）。术后单眼最佳矫正视力≥0．3共37只眼（59．68％）；双眼最佳矫正视力90．3为27例（87．10％）；随着随访时间的延长，患儿年龄的增大，双眼最佳矫正视力逐渐提高（R。=0．135，P=0．0024）；术后斜视7例，占22．58％；眼球震颤13例，占41．94％；视轴区混浊3例，占9．68％；高眼压1例，占3．23％。结论双眼严重的先天性白内障在婴儿期行白内障手术是安全的，通过及时的屈光矫正和弱视训练，绝大多数患儿能获得良好的生活视力；随着患儿年龄的增长，双眼视力有逐渐提高的趋势。

Objective To evaluate the long-term visual outcome and complications after bilateral congenital cataract surgery performed prior to 12 months of age. Methods A prospective case study. 31 cases （62 eyes ） of bilateral congenital cataract were included. All patients received bilateral cataract extraction combined with primary capsulotomy and anterior vitrectomy simultaneously. After the operation, all patients wore aphakic glasses during the follow-up period. The unilateral and bilateral visual acuities （VA） at the last visit were determined and post-operative complications were evaluated, and the relationship between bilateral VA and the length of the follow-up period was also analyzed. Results The median age at surgery was 3.0 M （0. 5 to 11 M）, the median follow-up period was 4. 0 years （ 3.0 to 8.5 years）. 37 out of 62 eyes （59.68%） achieved unilateral best corrected visual acuity equal or better than 0. 3. 27 among 31 cases （87. 1% ）achieved binocular best corrected visual acuity equal or better than 0. 3. Binocular best corrected visual acuity improved with the increase in the follow-up period and the patients＇ age （ R2 = 0. 135, P = 0. 0024）. Post-operative complications included strabismus （7 cases, 22. 58% ）, nystagmus （13 cases, 41.94% ）, optical opacity （3 cases, 9.68% ）, ocular hypertension （1 cases, 3.23% ）. Conclusions Surgery for congenital cataracts performed prior to 12 months of age is safe, and most of the subjects can achieve functional vision acuity. As these children age, the bilateral best corrected visual acuity can still keep improving.